TSF tibia Assayag

Hey guys, I had surgery last week. I had bowed legs which was genetic and unrelated to my femur surgery, but I was able to use insurance for a high portion of the cost. I can’t get into the specifics, but they paid for the codes which involved correcting my bowed legs, so that they don’t cause knee pain as I get older. This is my second rodeo after doing femurs, and I told myself I would only do it in the USA. It’s actually funny because I had my nail removal done at HSS a couple months ago and that’s when I was told I had bowed tibias and they asked if I wanted to correct it. I would have never found out if they did not mention.

I ended up emailing all the doctors and ended up going with Assayag. Initially I was going to pay for the nails out of pocket (genu varum correction would cover some of procedure) but I haven’t kept up with the prices, and thought they would be around 30k ish. Recently they went up by alot so that was not in my favor. I ended up just going with TSF. Also the HP house is a cripples paradise, and saved me so much cost. It’s a non profit housing that is nicer than a hotel and is across the street from Assayag and my PT. It’s very cost efficient to stay. I booked 3 months here and it was what I would pay for one months of rent in my apartment. My biggest expense will be food but they also have a kitchen here, I’m just lazy. I see other LL patients with meal preps. Keeps saying upload to big so will split

My surgery was Thursday, and honestly after doing femur externals it’s been kind of a cakewalk compared. It’s still been very tough, mentally and physically, but nothing in the realm of monorail external femur. I’d say TSF is a quarter or third of that difficulty.
The 4-5 days were definitely the worst. That’s probably also because I would only take Tylenol and no oxy, so after the hospital medicine wore off I was having depression and trouble sleeping and bad anxiety. I remember in Turkey everyone was on prescribed Xanax, lyrica, and tramadol through their femur LL period (including me). This is definitely manageable without. Today I felt much better, mentally and physically. I went to my first PT session and seeing the sun for the first time in about a week felt really good. Also my swelling is slowly going away. I did a couple hundred steps with a walker today, but when the inflammation medicine wears off I can’t do much. It’s really swollen and probably takes a couple weeks to go away. Even my feet look inflated.

I’m shooting for 2’ give or take. I did an ATL release as well. God willing it goes okay, and honestly I’ve never felt so comfortable than with Assayag. He has a larger than life personality, and feels more like your friend than your surgeon. I have his personal cell in the event I have any urgent situation, and he’s just overall a great surgeon and an awesome guy. Continues-> (comment to large)

HSS are great surgeons but  felt more like robots, Assayag treats you like his best friend. This is just my personal opinion. Also the directors of HP house bill and amy treat me like their children. They gave me a donor electric scooter to borrow and it’s made my life so much easier. The PT handle a ton of LL patients so it wasn’t awkward. I honestly have nothing but positive things to say about the people at Sinai.

Attached is a photo of my frames and me scootering back to my room after picking up an Uber eats order. https://imgur.com/a/FWwbTd0
 I am a firm believer that no one should put themselves through this. However, a lot of us are mentally ill. After femur LL I was relieved of this, and it wasn’t necessary. I just had a good amount of savings and thought this would make me happier than buying a new car or being richer etc, but it ended up being extremely cost efficient as well which is great. I’m just trying to thug it out now for the next few months, where I will probably insert a nail and remove the fixators, since I don’t want to keep them on for 7-8 months.

Lastly wanted to add pray for me through this process. I feel so much in good hands now compared to that butchering cash grab operation sedat has in turkey. I read now they’re charging like double for femur LON which is insane. The only selling point to that nightmare was the cost savings at the time. We should always remember to be grateful, even pre-LL I have to admit I was not grateful to not be born a cripple or something. I feel this is vanity none the less, best of wishes to all of us.

One week post-op. https://imgur.com/a/UW6lexG I am still very swollen. I took a cold shower today to try to help the swelling. I probably stagnated it with the hot showers the last couple of days.
Today was my first day of turning the struts (lengthening). The print out for lengthening & correction is really simple. Assayag is very conservative and wants me to do .5mm a day. I may ask if I can bump it up to .75mm as I am scheduled to see him every two weeks (next Thursday). I clean and bandage my pins after every shower and am extra careful not to cross contaminate between any of them (so that if one gets infected I do not spread it to the others). In the event they did it should be completely fine with a normal antibiotic treatment. I forgot to mention I also did gastro release (aside from Atl). My lower calf and Achilles area is very sore. I can stand unassisted now and manage a few baby steps unassisted. I have the unhumanly clicking in my right tibia, which isn’t painful at all just feels super uncomfortable. It’s natural with any LL, but you never get used to it.
Pins https://imgur.com/a/vQUrALN

I’m doing good enough now, but I’m a little salty about missing Halloween weekend and will miss new years celebrations. My friends are all having a great time on social media, which makes me a little jealous. It’s become a waiting/patience game at this point. My pain is pretty low through out the day and my discomfort is manageable. I just can’t really get comfortable with these fixators.

1. What does it cost to do tibia lengthening with tsf frames with Dr assyag?

2. How many days does 1 cm take to get? 45 days?

3. How long will you have to wear the frames, with and without inserting a nail after the lengthening?

4. Would you be able to fully weight bear, if your body was strong enough?

5. Before when you did 8 cm on your femurs, how did walking feel like afterwards? Like before or more clunky?

6. Did your proportions feel okay after doing femur lengthening?

Sorry for the many questions, but your're the perfect person to ask, since our starting height is the same, and 10 mm precice max will be an option in EU in the future and I can't do tibia internal precice

I don’t believe they offer it anymore unless you have some sort of deformity. Even one that does not affect your functionality (such as bowed tibias in my case). You would need to have X-rays done and send during a consult probably. If you’re paying out of pocket in the US there is no point to save 10-20k compared to internal, it’s definitely not worth the comfort sacrificed for months unless you can get insurance to cover a large portion of TSF.

Frame removal depends on how fast bone consolidates. Probably like 7-8 months for 5cm which I don’t want to do, so I’ll probably ask to remove and insert a trauma nail after lengthening. I’m weight bearing now. I feel this will bring my biomechanics into a my pre-ll range, as after femur they did change. I was still walking and running normal to the nked eye, but things just felt different and my center of gravity was in a different spot when getting up from sitting. It wasn’t significant to me and I didn’t really care, you get used to it 

Just updating, I had my follow - up last Friday, but forgot to take a picture on my phone of X-rays. I’ll upload once medical records sends me them.

I’ve lengthened close to a centimeter now, it’s still very early on. Assayag said everything looks good at this stage, but it’s so early on that he can’t really see much.
The second x-ray is the most important as you can see the regeneration and make an opinion on it. Most of the time I don’t have above minor pain, but I had a pinsite infection that was very painful for a couple days until the antibiotics kicked in. When I wake up I have inflammation especially by knees that is somewhat painful but once I take medicine it mostly goes away. Inflammation is what presses on the muscles/joints and gives you those weird/sharp pains, so I try to keep it at a minimum, also by walking assisted. The worst part about all this is not being comfortable when trying to go to sleep. It compounds day after day and makes you anxious, like being a passenger on a long road trip. No matter how you toss and turn you can’t get comfortable.

I walk with crutches, and for longer distance I use an electric scooter. The first 2 weeks of tibias give you balloon feet from the swelling, once that goes away it’s much easier to walk.

https://imgur.com/a/vaUL1Vu
I’m close to 4 weeks post-op. Walking with crutches video above
I try to cycle a little every now and then
https://imgur.com/a/vaUL1Vu

I’m a little antsy for my xray appointment this Friday, as I’ll know if everything is going okay or if there are any issues. I went to PT today and they noticed I still have slight swelling. Pushing their finger into my foot, it leaves an indent that takes a little bit to go away. I have full ROM and no tightness yet, I don’t really anticipate much since the releases.
Assayag advised .5mm a day but honestly after the first xray /followup I started doing .75mm which is the max safe range for tibias, but bad as this is against his orders/advice. I’m hoping there’s no issue, as you cant tell much about bone formation from the first xray so I should have stayed in the conservative range. I just really want these fixators off. During the day I am busy so it’s not bad, but at night I cannot relax at all, and it’s so tough to sleep. I started taking my oxys to sleep a couple nights ago, and also due to pain. I’ve been getting a throbbing pain in my left knee at night, that’s bearable but like a 4/10. It’s not nerve or muscle pain, but I think inflammation pressing on the joints. If I push on the area it’s painful, and it doesn’t fully go away even with Tylenol and inflammation medicine. It’s normal from what I’ve read, as you adjust the TSF. I’m not worried about getting addicted, as I was on xanax and opioids for a few months with my femur fixators, and although it was hard I quit them cold turkey after fixator removal. At this point it’s whatever helps, and I’m just trying to stay patient. Sometimes I feel really down and sometimes I feel okay. Whenever I feel down I try to remember how much worse the femur fixators were and I pushed through that. I’m just praying my formation is good and I’ll ask if I can maintain .75mm. That will allow me to hopefully get these off in around a month and a half, which seems like a short time for a regular person, but with fixators it’s a big hill to climb over. A few months total is not long at all, but you get slightly detached from society during this process and I miss my social life and friends.

https://imgur.com/a/JiidiOY
X-rays^ . I’m barely above 1cm. My bone regeneration is good but not great/excellent. I’m doing everything right as far as nutrition but my calorie intake isn’t enough. I’m eating around 2k a day but to support faster broken healing I need to probably bump it up to 3k at least, but I get full very easily. I broke it to Assayag I was going a little faster (.75) some days and he wasn’t too happy about it. I promised to slow back down to .5mm for now, hoping he bumps me up in the future if I heal faster. Mentally it’s still a rollercoaster, mainly at night when I try to sleep is when It hits me. I just can’t shut off & get irritated and anxious due to lack of comfort, and I also have lower back pain from sitting most of the day.

There’s a guy here that got bumped up to 1.25mm per day on femurs because his healing/consolidation is insanely fast. He also eats half a dozen times a day. He’s connaways patient however, not assayags. I’m sure part of it is also genetics, as they are twice my age and a different ethnicity.
Pain is uncommon and 3/10 max when it comes. By far the toughest part is the mental patience